Week 12: Living with grief and loss
Recording:
Miss the class? Want to hear it again? Join Dr. Minoo as she explains the lesson on grief and loss.
A few comments from Wednesday class
Types of grief mentioned in chat:
Retirement because of illness (loss of job gave me purpose)
What helped with grief?
Family members, close friends and time can help
A friend gifted me with a wonderful teddy bear & 2 pillows made from different shirts of my late husband. I also helped design a quilt from other shirts of his with a friend. I find those comforting. Learn more:
Write the story out, make a photo collection,
Thoughts on grief:
Grief is the last act of love we have to give to those we love. Where there is deep grief, there was great love. This was given to me when I lost my husband in 2011.
The reality issues you have to face will delay your grief
I guess bc Death of a loved one, or considering Our Death won’t be a BF topic, despite our connections /interests in the topic, bc it’s not a direct connection to Brain Fitness!
Resources to cope:
Living with grief and loss
This week we are going to gently step into a conversation about a difficult topic. The topic is grief. Grief is universal, and yet it feels so personal. The emotions with grief can overwhelm us, scare us, and make us want to hide. We often try to avoid a discussion that makes us uncomfortable. Today’s discussion is an invitation to listen, engage, or both. There are no rules, requirements, or expectations. Walk as far, or as little, into this topic as you like.
Grieving is learning
Mary-Frances O'Connor is an associate professor of psychology at the University of Arizona. She studies what happens in our brains when we experience grief. She says grieving is a form of learning. It teaches us how to be in the world without someone we love in it. "The background is running all the time for people who are grieving, thinking about new habits and how they interact now.", shared Dr. O’Connor. (Kwong & McCoy, 2021)
Dr. Connor believes that adjusting to the fact that we'll never again spend time with our loved ones can be painful. It takes time, and involves changes in the brain. Dr. Connor states, "What we see in science is, if you have a grief experience and you have support so that you have a little bit of time to learn, and confidence from the people around you, that you will in fact adapt." (Kwong & McCoy, 2021)
Dr. Connor continues. When we have the experience of being in a relationship, the sense of who we are is bound up with that other person. The word sibling, the word spouse implies two people. And so, when the other person is gone, we suddenly have to learn a totally new set of rules to operate in the world. The "we" is as important as the "you" and "me," and the brain, interestingly, really does encode it that way. When people say, "I feel like I've lost part of myself," that is for a good reason. The brain also feels that way, as it were, and codes the "we" as much as the "you" and the "I." (Kwong & McCoy, 2021)
What is grief?
Grief is the experience of coping with loss. Many think of grief as happening during the painful period following the death of a loved one. But, grief can accompany any event that disrupts or threatens our send of normalcy. This includes the loss of connections with activities or experiences that help us to define ourselves. (Cleveland Clinic, 2023).
We may experience grief due to the loss of:
· A loved one, including a pet
· A marriage, friendship, or other form of relationship
· A home, neighborhood, or community
· A job or career
· Financial security
· A dream or goal
· Good health
· Youth
· Fertility
· The ability to continue an activity
We may also grieve the loss of life as we know it. For example, we may be diagnosed with a life-threatening illness and grieve our loss of time to experience or achieve the things we had desired.
What is the difference between grief and grieving? Grieving is the process of working through grief.
https://www.choosingtherapy.com/types-of-grief/
What are examples of types of grief?
There are an infinite number of ways to experience grief. Let’s take a look at a few types of grief as examples of how varied and complex grief can be. (Cleveland Clinic, 2023)
Anticipatory Grief
Anticipatory grief involves grieving before an actual loss. For example, we may begin to grieve when we learn that a loved one has a terminal illness. Processing grief beforehand can help us to prepare and face the loss when the time comes. (Conrad, 2023).
Delayed Grief
Rather than immediately experiencing the emotions that accompany grief, we may feel them days, weeks, months, or even years later. In some instances, the shock of a loss can delay our bodies’ abilities to work through emotions. We may be so busy handling practical matters associated with a loss, that we don’t allow our bodies to grieve until the responsibilities have been addressed. (American Psychiatric Association, 2024)
Cumulative Grief
Cumulative grief involves working through multiple losses at the same time. For example, we may be grieving the loss of a child, at the same time we are grieving the dissolving of our marriage and even a job loss. Simultaneously grieving multiple losses makes the process of grieving significantly more complex and difficult in unexpected ways. (Pathways, 2024)
Complicated Grief
Grief is never simple. But it can become more complicated by factors such as the following. (Mayo Clinic, 2024)
· Absent Grief: This is when we do not show any signs of grieving. We may be frozen in denial. This prevents us from processing our emotions and moving forward. It can result in unpredictable emotions and behaviors that lead us to feel more confused and detached from ourselves.
· Ambiguous Loss: This occurs when there is a lack of closure surrounding a loss. We may lose someone we love, but the body of our loved one is never found or returned. Ambiguous loss can also occur when our loved one is still alive, but out of reach. This may be the case if someone is incarcerated, deported, living far away, or refusing any contact from us. It may occur if our loved one is experiencing severe dementia and no longer knows us.
· Disenfranchised Grief: Sometimes society does not consider a loss to be worthy of grieving. This can include deaths due to suicide or drug overdose. It can also occur when society has determined that an individual should die, and the family members of the person do not have a right to grieve.
· Traumatic Grief: Sometimes we experience a loss and trauma at the same time. This may occur if we lost someone under horrific or unpredictable circumstances such as a natural disaster or an accident. Those who have served our country while fighting a war, and who lost fellow soldiers, may experience grieving and PTSD due to the trauma of war.
· Survivor Grief: A person who survives a traumatic event when others involved in the traumatic event do not, may experience survivor guilt. The survivor may ask “Why me? Why do I deserve to live?”. This person may also have feelings of guilt as the person wonders if enough was done for others.
Abbreviated Grief
Sometimes, we’re able to quickly move through the grieving process. This is abbreviated grief, and it may follow anticipatory grief. We may quickly grieve a loss because we’ve already done a lot of emotional processing while anticipating that loss. Grieving for a short time doesn’t mean we never truly cared. We are all on different timelines when it comes to grief. (Epstein, 2021)
Inhibited Grief
Inhibited grief involves repressed emotions. Most of us have not been instructed in how to process, or even recognize, the many complicated and confusing emotions that we may experience when we are grieving. Thus, many of us repress our emotions without realizing it. Unfortunately, when we prevent ourselves from feeling these emotions, grief can show up as physical symptoms that impact our health. This may include pain in specific parts of our bodies, sleeping and eating disruptions, withdrawal, and much more. (Cleveland Clinic, 2023)
Collective Grief
We usually think of grief as a personal process, however, groups of us sometimes grieve together. Family members grieve together when they lose a loved one. Major events, such as wars, natural disasters, school shootings, and pandemics can create far-reaching losses. They can result in large scale changes in how we live as communities and societies. As a group, we grieve the shared experience as we ideally work together to support one another through it. (Cleveland Clinic, 2023)
What are some of the more common symptoms of grief?
Emotional Symptoms
The range of emotions that we may experience as we grieve is infinite. Every emotion we feel when we are in a close relationship, can be included in those we experience with loss. Panic, anxiety, sadness, and yearning are common emotions. We can also find ourselves challenged to maintain focus and confused as we attempt to complete our usual daily activities. (Kwong & McCoy, 2021)
The intensity of emotions may surprise us. Grief can feel like someone turned up the dial on our emotions. Anger, intense anger, may be the emotion that is most likely to interfere with our relationships. Perhaps we surprise ourselves as much as we surprise others when we unexpectedly blow up at someone who makes a passing comment. It is important to find a safe way to express our anger, a way that we will not regret.
People who are grieving often describe their emotions as coming in waves. It can feel as if the emotions roll over us like a large wave, coming in without warning. One minute we may feel like our lives will return to normal, and the next we can barely breathe, and tears are flowing down our faces.
Grief often forces us to experience a very broad range of emotions, from sadness to anger and even to joy. It is common for us to feel detached from our emotions. As if we are on autopilot and looking at ourselves from the outside. (Cleveland Clinic, 2023)
These are a few examples of confusing and conflicting emotions that are common during the grieving process.
· Sadness because a loved one has passed, but relief that this loved one is at peace.
· Yearning for a spouse after a divorce, but excited at the opportunity of finding someone new.
· Guilt for feeling grateful that we no longer have to provide caregiving for a dying loved one.
· Competing feelings of apathy, anger, sadness, regret, and guilt as we grieve the loss of a friend or family member with whom we had a strained or hostile relationship.
There are no right or wrong emotions when it comes to grief. There is no timeline on grief. No rule regarding when it must begin or end. It is important to process the emotions and continue the path to healing.
Physical Symptoms
Grief can take a major toll on our physical bodies. It can overwork our nervous systems, weaken our immune systems, and lead to all kinds of physical health challenges. (Cleveland Clinic, 2023)
These symptoms may include.
· Fatigue
· Headaches
· Nausea
· Restlessness
· Heart palpitations
· Weak muscles
· Tightness in the chest and throat
· Reduced or increased appetite
· Sleep disruptions
· Pain in any part of the body
https://www.choosingtherapy.com/grief-brain/
Video:
A short video on how grief affects the body.
https://www.choosingtherapy.com/grief-brain/
Cognitive Symptoms
Grief can interfere with our ability to concentrate and complete day-to-day tasks. The symptoms can include the following.
· Confusion
· Difficulty thinking or making decisions
· Difficulty finding a purpose in life
· Difficulty focusing on anything other than the loss
· Difficulty remembering or keeping track of responsibilities
Grief Theories
We are going to spend a few minutes briefly reviewing a few different theories that each attempt to explain the experience of grief. No one theory is accepted by all. Ideally, you may find a theory that resonates with you, and may be helpful as you journey through life and seek to support those who are in the process of grieving.
Dual Process Model of Grief
The Dual Process Model of Grief incorporate two different approaches. The first is Loss-Oriented Coping. Loss-Oriented Coping refers to traditional grieving processes that seek to maintain a relationship with the deceased, typically through reoccurring and consistent focusing on, and memories of, the loss and the deceased. A wide range of fluctuating emotional experiences are common. The second approach involves Restoration-Oriented Coping, in which we adjust to new identities and roles in response to losing our loved one. For example, if we lose a spouse we will assume responsibility for tasks that had been taken care of by our spouse. We may also choose activities to distract ourselves from the loss and enable us to move on.
The Dual Process Model of Grief hypothesizes that we fluctuate back and forth between Loss-Oriented Coping and Restoration-Oriented Coping. At times, we are able to cope with the loss of our loved one and take steps forward, and at other times we feel consumed by our memories
This is a reminder that the process of grieving and healing is not linear. Some days we may feel we are moving forward, and other days we may feel stuck in our grief.
Tonkin’s Model of Grief
Lois Tonkin was a grief counselor who conceptualized grief as a process that involved “growing around the grief.” According to the Tonkin Model, grief may be overwhelming in the initial stages. With time, the grief remains, but it becomes smaller and no longer consumes one’s entire life. Other areas of an individual’s life grow larger and become more significant than the loss.
New experiences, such as learning, traveling, and new social relationships begin to create moments of happiness that account for more and larger portions of a person’s life as the grief becomes less dominant. Resilience develops over time. Although smaller, the grief remains in the background and may rise to the surface from time to time. This model hypothesizes that we incorporate grief into our overall identity at the same time that we are finding happiness in our areas of our lives.
Stage Theories of Grief
There are several stage theories of grief, each proposing that we move through predictable, predetermined stages as we grieve.
Worden’s Four Tasks of Grieving Model
Psychologist J. William Worden provides a framework of four tasks that help us understand how people journey through grief. Healing happens gradually as grievers address these tasks, in no specific order, going back and forth from one to another over time. (Our House, 2024)
Task 1: To Accept the Reality of the Loss
Although you know intellectually that the person has died, you may experience a sense of disbelief. Integrating the reality of the death means “taking it in” with your whole being. For example, the reality may begin to set in immediately after the death, when you must call the mortuary, attend the memorial, or pick up the ashes. Many weeks, months or years later, the reality again hits you as you realize that your loved one has died, and this person isn’t here to share these moments with you.
Task 2: To Process the Pain of Grief
Grief is experienced emotionally, cognitively, physically, and spiritually.
People may be telling you: “Get over it; move on; be strong.” In contrast, one of the aims of grief support groups is to encourage and facilitate the safe expression of all the natural grief reactions.
Task 3: To Adjust to a World Without the Deceased
External adjustments include taking on responsibilities and learning new skills. Internal adjustments are made as you adapt to your new identity.
Spiritual adjustments occur as you grapple with questions about your belief system and the purpose and meaning of life.
Task 4: To Find an Enduring Connection with the Deceased in the Midst of Embarking on a New Life
Gradually you create a balance between remembering the person who died and living a full and meaningful life.
Elisabeth Kubler-Ross Five Stages of Grief (Grief.com, 2024)
Denial. Denial and shock help us to cope and make survival possible. Denial helps us to pace our feelings of grief. It is nature’s way of letting in only as much as we can handle.
Anger. Anger is a necessary stage of the healing process. There are many other emotions under the anger. For example, underneath anger is pain.
Bargaining. Before a loss, we do anything if only our loved one would be spared. “Please God, ” we may bargain, “I will never be angry at my wife again if you’ll just let her live.” After a loss, bargaining may take the form of a temporary truce. “What if I devote the rest of my life to helping others. Then can I wake up and realize this has all been a bad dream?”
Depression. After bargaining, our attention moves squarely into the present. Empty feelings present themselves, and grief enters our lives on a deeper level, deeper than we ever imagined. This depressive stage feels as though it will last forever, but it won’t.
Acceptance. Acceptance is often confused with the notion of being “all right” or “OK” with what has happened. This is not the case. Most people don’t ever feel OK or all right about the loss of a loved one. This stage is about accepting the reality that our loved one is physically gone and recognizing that this new reality is the permanent reality.
Stage theories can help us to conceptualize the process of grieving, but they are not perfect. Not everyone who grieves experiences each stage or experiences the stages in a predetermined order. Some of us may skip a stage, repeat a stage, or remain in a stage for varying lengths of time. But the stage theories are helpful in reminding us that the process of grieving can include some common emotional and cognitive responses, none of which necessarily last forever.
Meaning Reconstruction Theory
In contrast to stage theories, the Meaning Reconstruction Theory proposes that reconstructing meaning is central to the grieving process. This theory attempts to describe grieving as an effort to recreate a sense of self in the face of loss. The recreation of ourselves is deeply personal. It involves creating a personal narrative based on life lessons.
Although very personal, factors around us can influence the narrative that we each create for ourselves. These factors can include our gender, age, our relationship with our loved one, and cultural messages. From the Meaning Reconstruction Theory, we may understand that we all make sense of our loss in different ways, and at the same time, may share some common themes.
What is happening in our brain as we grieve?
Psychologist Dr. Mary Frances O’Connor explores what happens in our brains when we experience the loss of a loved one. In her book, The Grieving Brain, she describes neuroimaging studies that capture snapshots of the momentary reactions of those yearning for a loved one. She claims that we are in the very early days of examining the neurobiology of grief, with only a handful of studies that have involved looking at more than one moment, with the same person, across time. With more research, Dr. O’Connor is confident that she and others will be able to map the trajectory of grieving in the brain.
At this time however, what is known about how the brain responds to grief is based only on snapshots. The evidence seems to indicate that grief is tied to all sorts of different brain functions. Grieving involves the recall of memories, taking the perspective of the one who has passed and those who knew the person, changes in the regulation of our heart rates, differences in how pain and suffering manifest, and a variety of different emotional and physical reactions. Dr. O’Connor maintains that grief involves many different areas of the brain, that the impacted areas change over time, and that they vary by individual. While at the same time, anticipating that future studies will reveal common brain responses as we each grieve. (O’Connor, 2024; Kwong & McCoy, 2021)
Video:
In this wonderful Ted Talk, Mary Francis O'Connor reviews her thoughts on grief and what happens in the brain. She helps us to understand how the brain sees grief. Lots of insights including the importance of sharing our grieving experiences and realizing that we grieve because we loved.
How long does grief last?
The American Psychological Association defines grief as lasting from 5 months – 2 years, with symptoms gradually improving over time. However, it is very important to remember that there is no rule about the length of the grieving process. There is no shame in grieving for longer or shorter periods of time.
If you would like support as you experience grief, reach out to a medical professional, spiritual advisor, grief counselor, or other expert who can assist you.
How do we cope with grief?
As we have discussed, coping with grief takes time and patience with ourselves. Here are a few things we may be able to do to support ourselves as we grieve. (Cleveland Clinic, 2023)
• Practice self-care. Your health is critical to your ability to work through the process of grieving. Make sure you get good quality sleep, eat healthy foods, move your body throughout the day, make time for loved ones and friends, engaging in learning, and do things that you enjoy. You will be better able to help others, and yourself, if you are healthy.
• Stick to a routine. Grief can interrupt your sense of normalcy and disrupt your emotions too. Sticking to a routine may help you to regain a sense of control over your life, and ease intense negative emotions. Go to bed and get up in the morning at consistent times. Stick to a regular schedule for meals. Be sure to bathe or shower regularly, and reach out for social connections.
• Attend to your emotions. Try to resist the urge to use work or hobbies as a way to distract yourself from your emotions. Grieving hurts. It can involve crying and sobbing. Be comfortable, without shame, crying. At the same time, see if you can remember moments of joy that you shared with your loved one. Try to move your grief outward by expressing what this person meant to you. Perhaps you journal, paint, tell stories, write music, or in another way express your love, pain, and other emotions.
• Reach out to others. Remind yourself that you have positive connections with people. While it is fine to spend some time alone, avoid sliding into isolation. Remind yourself that people are around you, people who want to, and can, support you.
• Speak with a therapist or grief counselor. Working through grief can be the hardest thing for any of us to do in life. Finding someone with the skills to guide us can make the journey easier and healthier. Reach out to a professional and see if you can get effective support.
Video:
In this wonderful and inspiring video, we see how one person uses her grief to make peace with herself. She suggests a mindful approach, to sit with our grief and allow us to process it. And then, do something good things with your grief. Very inspiring talk!
Video:
In this video, we learn about two grandmothers and how they grieve. We then hear some thoughts about how we can get through grief, not be blocking emotions but by embracing the emotions including the grief. Change your perception of grief. Honor our loved ones by living well.
How do we support someone who is grieving?
As much as we want to do it, it is not always easy to find the right words or behaviors to support someone who is experiencing loss. The following ideas may be helpful. (Cleveland Clinic, 2023)
• Be present. Make yourself available based. No one, including your friends and family members who are grieving, expect you to be a grief expert or to say the exact right words. Being there can be enough. By being present you may help the person feel less alone. You may also see ways that you can help.
• Offer to help. Many people who are grieving do not feel comfortable asking for help, may not know how to ask for help, or make not know what to ask for. See if you can identify ways, even small ways, that you can help. Maybe you pick up groceries or provide meals. Perhaps you do the laundry or mow the yard. The grieving person may want a ride. The person who is grieving may also appreciate help in planning arrangements or desire a companion who can be present at key meetings.
• Signal that you are open to listening. You may notice that the person who is grieving does or does not want to talk. Look for cues. Does the person mention the loved one who has passed, by name? Does this person tell stories about the loved one? See if you can mirror the behaviors of this person, as you allow this person to determine conversations.
• Validate the loss. Allow the one who is grieving to honestly process emotions. Be careful not to minimize someone’s loss. Avoid communicating that a loss wasn’t a big deal, or that it is time to move on. Avoid putting a positive spin on the loss. Statements such as “It’s all for the best” or “She is in a better place now” can sound dismissive.
What do I say?
It can be very difficult to know what to say to someone who has lost a loved one. Please use your personal judgement, and notice how a person responds, as you identify what to say or not say. The following examples may or may not fit well for a specific individual.
We may be very well intentioned, but there are a few things that we should probably not say. It can be difficult to find the right words. And the “right” words will be different for different people.Be kind to yourself if you make a misstep. It is not always possible to find the words to clearly express what we feel.
The following are examples of what we do not want to say:
Summary
Grief can feel so personal, and yet, it is something all of us experience in our lives. Each of us may grieve in different ways, with moments we feel lost in the grief and other moments in which we begin to see ourselves moving forward. Grief can feel overwhelming. Being gentle and patient with yourself, and with others who are grieving, supports healthy responses. Reach out to a grief counselor, therapist, spiritual guide, or other trusted expert for support as you walk the path from loss to healing.
Note: Our course website contains some valuable mental health resources if you or someone you know are struggling. You can find this under "resources for students" or click here to get to the page.
References
American Psychiatry Association (2024). Prolonged grief disorder. American Psychiatry Association. Downloaded March 17, 2024 from https://www.psychiatry.org/patients-families/prolonged-grief-disorder
Cleveland Clinic (2023). Grief. Downloaded March 14, 2024 from https://my.clevelandclinic.org/health/diseases/24787-grief
Conrad, M. (2023). Anticipatory grief: What is it and how to cope. Forbes Health. Downloaded March 17, 2024 from https://www.forbes.com/health/mind/what-is-anticipatory-grief/
Epstein, F. (2021). 3 reasons we might not grieve a big loss. Psychology Today. Downloaded March 17, 2024 from https://www.psychologytoday.com/us/blog/between-the-generations/202103/3-reasons-we-might-not-grieve-big-loss
Grief.com (2024). The five stages of grief. Downloaded March 17, 2024 from https://grief.com/the-five-stages-of-grief/
Kwong, E. & McCoy, B. (2021). What happens in the brain when we grieve. npr, kbps. Downloaded March 14, 2024 from https://www.npr.org/2021/11/04/1052498852/what-happens-in-the-brain-when-we-grieve
Mayo Clinic. (2024). Complicated grief. Downloaded March 17, 2024 from https://www.mayoclinic.org/diseases-conditions/complicated-grief/symptoms-causes/syc-20360374
O’Connor, M-F. (2024). How do we cope with loss and grief? https://maryfrancesoconnor.org/
Our House Grief Support Center (2024). Worden’s Four Tasks of Mourning. Downloaded March 17, 2024 from https://www.ourhouse-grief.org/grief-pages/grieving-adults/four-tasks-of-mourning/
Pathways (2024). Grieving multiple losses at once. Downloaded March 17, 2024 from https://pathwayshealth.org/grieving-multiple-losses-at-once/